Journal Article

Military Generation and Its Relationship to Mortality in Women Veterans in the Women’s Health Initiative

Donna L. Washington, Chloe E. Bird, Michael J. LaMonte, Karen M. Goldstein, Eileen Rillamas-Sun, Marcia L. Stefanick, Nancy F. Woods, Lori A. Bastian, Margery Gass and Julie C. Weitlauf

in The Gerontologist

Volume 56, issue Suppl_1, pages S126-S137
Published in print February 2016 | ISSN: 0016-9013
Published online January 2016 | e-ISSN: 1758-5341 | DOI: http://dx.doi.org/10.1093/geront/gnv669
Military Generation and Its Relationship to Mortality in Women Veterans in the Women’s Health Initiative

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  • Geriatric Medicine
  • Biological Sciences
  • Psychology
  • Care of the Elderly
  • Gerontology and Ageing

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Purpose of the Study:

Women’s military roles, exposures, and associated health outcomes have changed over time. However, mortality risk—within military generations or compared with non-Veteran women—has not been assessed. Using data from the Women’s Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women.

Design and Methods:

WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation.

Results:

After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09–1.23) for pre-Vietnam and 1.16 (95% CI: 0.99–1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64–5.23).

Implications:

Veterans’ higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.

Keywords: Women Veterans; Mortality; Cohort effect; Longitudinal study

Journal Article.  7719 words.  Illustrated.

Subjects: Geriatric Medicine ; Biological Sciences ; Psychology ; Care of the Elderly ; Gerontology and Ageing

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